Martha, a four-year-old Standard Poodle, had always been a ‘sensitive’ dog. She’d had multiple trips to the vets for various upset tummies, and her owners, Mr and Mrs Taylor, had always struggled to find a food that she would consistently eat and didn’t seem to give her any bouts of vomiting or diarrhoea. But when the Taylors’ adult son found Martha collapsed on the living room floor when he came home very late one evening, they knew they had to act fast. Martha was cold, unresponsive and surrounded by pools of vomit. The Taylors rushed her to their emergency vet, terrified that she wouldn’t make it. 

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Martha was examined immediately by the duty veterinary surgeon. She was conscious, but extremely depressed and lethargic, with a slow heart rate, mild dehydration and a low temperature. She was taken through for urgent blood tests and stabilisation.

After an anxious wait, the vet returned to speak to Mr and Mrs Taylor

Martha had been placed onto a drip and was receiving emergency care to stabilise her heart rate and blood pressure as they awaited some blood results. The vet discussed Martha’s health up until this point, any changes to her environment and any potential access to poisons. Her owners mentioned that she had had a few tummy upsets and minor illnesses up until this point, but nothing major. The vet was suspicious, given this history of being “not quite right” for a while, that she might have Addison’s Disease.

What is Addison’s Disease?

Addison’s, or hypoadrenocorticism, is caused when a dog’s adrenal glands don’t produce two important hormones: cortisol and aldosterone. This is usually due to immune-mediated destruction of the glands. Cortisol and aldosterone are essential for various life functions, including regulating levels of sodium and potassium in the blood. Addison’s can affect any dog, but is most common in young to middle-aged females. Predisposed breeds include the Standard Poodle, Great Dane, Portuguese Water Dog and West Highland White Terrier.

Symptoms of Addison’s disease are often vague and intermittent 

The disease can develop very slowly. Signs include vomiting, diarrhoea, increased thirst and urination, lethargy and a reduced appetite. Sometimes, dogs can present in an ‘Addisonian crisis’ which can be life-threatening. Signs include acute vomiting and diarrhoea, collapse, slow heart rate and coma. 

Martha’s blood results were soon back and showed some marked abnormalities

Her sodium levels were very low (hyponatraemia) and her potassium levels very high (hyperkalaemia). She also had a low blood glucose and some changes to her kidney values. The vet explained that Martha likely had Addison’s disease based on these results, and was currently suffering from an Addisonian crisis. There was a further test to be performed, to check the function of the adrenal glands, which they could do once Martha was stable. 

Treatment for Addison’s Disease

Patients in a Addisonian crisis need immediate veterinary attention, as the condition is extremely dangerous. The mainstays of treatment involve treating the shock, correcting blood volume and pressure and to correct electrolyte abnormalities. High potassium levels can be life-threatening as the heart rate is affected, and so medication may be given to bring these levels down safely but rapidly.

Chronic management for stable patients requires lifelong supplementation to replace the cortisol and aldosterone hormones. This is usually done using a monthly injection of desoxycorticosterone pivalate (DOCP) alongside daily steroid tablets. Treatment is lifelong and requires regular veterinary monitoring. Dogs may need additional steroid medication at times of stress, such as staying in kennels or travelling.

Martha was an inpatient at the emergency vets for three days before she was stable enough to come home

The Taylors were overjoyed to have her home, and even happier that her large vet bill was covered by their insurance policy. Martha was started on long-term treatment for Addison’s at her usual vets. She had to have multiple vet visits and blood tests initially until they found a dose of medication that worked the best for her, but the Taylor family were just so pleased she’d come through that terrifying night that they didn’t mind how often she needed ferrying back and forth to the vet clinic. The insurance company continued to cover her ongoing treatment costs. 

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Addison’s in dogs: the prognosis

With appropriate treatment and monitoring, Addison’s disease has a good prognosis in dogs. Having a concurrent disease, such as diabetes, or another crisis episode, does make the prognosis poorer but most dogs go on to lead normal lives.

Martha continues to do well at home. She has her injection every month, and daily steroid tablets which Mrs Taylor hides in a piece of chicken every morning. She needs extra steroids occasionally – but she’s always happy to have them in another slice of chicken!

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Some details changed for anonymity